Healthcare Provider Details

I. General information

NPI: 1982667069
Provider Name (Legal Business Name): NKIRUKA SANDRA NNEBE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA NNEBE

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 KNIGHTS RD
PHILADELPHIA PA
19114-4200
US

IV. Provider business mailing address

2500 MARYLAND RD STE 504
WILLOW GROVE PA
19090-1226
US

V. Phone/Fax

Practice location:
  • Phone: 215-612-4000
  • Fax:
Mailing address:
  • Phone: 215-481-6836
  • Fax: 215-481-5788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD426961
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD426961
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: